尿道下裂术前尿道功能的尿动力学评估

目的 探索小儿先天性尿道下裂术前尿道的功能状态及其临床意义.方法 对2～6岁尿道下裂患儿60例和正常小儿 66例进行对比研究.采用超声检查膀胱及上尿路形态;尿流率测定仪纪录尿流曲线、最大尿流率、平均尿流率、排尿量、排尿时间、尿流时间、最大尿流时间等参数;用膀胱容量测定仪测量膀胱残余尿量.结果 尿道下裂组和正常对照组小儿超声检查均未发现膀胱和上尿路形态学异常.尿道下裂组最大尿流率、平均尿流率、排尿量、排尿时间、尿流时间、最大尿流时间和残余尿量分别为(10.2±3.7)ml/s、(6.7±2.7)ml/s、(126.1±58.0)ml、(19.8±10.8)s、(19.1±10.7)s、(8.7±6.0)s、(18.9±19.3)ml.而正常对照组相应各值分别为(12.3±2.9)ml/s、(8.0±2.3)ml/s、(104.5±54.0)ml、(13.7±7.7)s、(12.6±6.7)s、(6.6±4.0)s、(12.3±12.0)ml.可见尿道下裂组最大尿流率、平均尿流率小于对照组,而排尿时间、尿流时间、最大尿流时间长于对照组,其差别均有统计学意义.尿道下裂组钟形曲线占56.7%,平台曲线占30.0%,而对照组分别为89.4%、3.0%,其差别也有统计学意义.结论 先天性尿道下裂患儿术前尿道功能异常,存在无症状的梗阻.     

小儿下尿路尿流动力学研究进展

下尿路尿流动力学检查技术在６０年代开始应用于小儿泌尿科领域，为各种小儿排尿障碍的诊断提供了新的客观依据。随着这种技术的不断改进以及资料的不断积累，目前许多小儿泌尿科工作者都把该技术放在与Ｘ线造影同等重要的位置，使其成为小儿排尿障碍诊断及指导治疗的重要手段。下尿路尿流动力学检查技术主要包括尿流率测定、尿道压力分布测定、膀胱压力容积测定、括约肌肌电图等内容。在检查方法上有常规尿流动力学检查、影像尿流动力学检查、以及动态尿流动力学检查等等。膀胱压力容积测定是一种以曲线形式反映膀膀容量及压力函数的检查，…     

前尿道瓣膜切除术后膀胱功能异常与上尿路损害的关系

目的探讨前尿道瓣膜切除术后造成上尿路持续损害的尿动力学危险因素。方法回顾性分析2007年1月至2020年1月26例前尿道瓣膜切除术后患儿的临床资料,平均年龄3.4岁(5个月至14岁)。瓣膜切除术后4个月至12.5年,平均5.5年。患儿术后均进行尿动力学检查。手术前后均进行血生化(包括尿素氮、肌酐)检查、泌尿系统B超检查、静脉肾脏造影(intravenous pyelography,IVP)和排尿性膀胱尿道造影(voiding cystourethrogram,VCUG)。比较瓣膜切除前后肾和输尿管积水以及膀胱输尿管反流情况,分析造成前尿道瓣膜术后上尿路持续损害的危险因素。结果前尿道瓣膜切除手术前肾和输尿管积水患儿共15例24侧,占57.7%(15/26);膀胱输尿管反流8例11侧,占30.8%(8/26)。瓣膜切除术后有5例7侧肾和输尿管积水消失,占19.2%(5/26);2例3侧膀胱输尿管反流消失。瓣膜切除术后肾和输尿管积水患儿共10例17侧,占38.5%(10/26);膀胱输尿管反流6例8侧,占23.1%(6/26)。有7例11侧肾和输尿管积水较术前加重,占26.9%(7/26),其中4例6侧膀胱输尿管反流较术前加重。根据术后肾和输尿管积水以及膀胱输尿管反流恢复情况,分为上尿路损害加重组(7例)和上尿路损害减轻或消失组(19例)。行瓣膜切除术后尿动力学检查发现,在上尿路损害加重组7例患儿中,压力流率图显示5例依然存在下尿路梗阻或可疑梗阻。上尿路损害减轻或消失组19例患儿压力流率图均显示无梗阻(P<0.05);两组最大尿流率平均值、膀胱顺应性、排尿期最大逼尿肌压力值差异均存在统计学意义(P<0.05);上尿路损害加重组中5例动态VUCG显示排尿时膀胱颈全程开放不全,行膀胱尿道镜检查发现3例膀胱壁增厚,呈小梁样改变和膀胱假性憩室形成,尤其膀胱基底以及膀胱内口附近组织明显增厚。结论前尿道瓣膜是一种罕见的下尿路梗阻性疾病,瓣膜切除之后上尿路损害仍然会持续存在或加重,可能与患儿异常的膀胱功能有关。排尿期最大逼尿肌压力升高、最大尿流率低、膀胱顺应性低以及压力流率图显示梗阻仍存在是导致膀胱功能异常的尿动力学危险因素,可能与前尿道瓣膜患儿同时存在膀胱颈部功能与结构的异常有关。     

脊髓栓系的尿动力学表现及临床意义

目的：探讨及评价脊髓栓系的尿动力学表现及临床意义。方法：对66例脊髓栓系患儿行尿动力学检查、MRI和排泄性膀胱尿道造影。结果：58例患儿发现有尿动力学异常改变，逼尿肌反射亢进35例，反射低下25例，逼尿肌括约肌不协调27例。54例膀胱顺应性，逼尿肌压增加，53例 残余尿增加，51例膀胱容量减少。8例尿动力学表现正常。脊髓圆锥位置正常5例，位于L3－L5间32例，L5以下29例。输尿管反流16例。结论：脊髓栓系可导致尿动力学发生不同的异常改变，脊髓圆锥位置与尿动力学表现的类型及上尿路损害无相关关系，上尿路损害与逼尿肌括约肌不协调、逼尿肌压和患儿的年龄密切相关。尿动力学检查是评价下尿路功能和治疗的客观指标。     

305例原发性遗尿症儿童尿流率检测结果分析

目的通过分析尿流率检测结果评价原发性遗尿症患儿的膀胱尿道功能。方法选择2001年10月￣2005年8月在我院尿动力学室进行尿流率检测的原发性遗尿症患儿。患儿先饮水,待有强烈尿意时,在不受干扰的环境中采取自然体位排尿于尿流率测量仪器上。记录最大尿流率、平均尿流率、排尿时间、尿流时间、尿量、达峰时间及尿流曲线等,同时于肛门口贴电极片同步测量盆底肌募集肌电图。结果原发性遗尿症患儿共305例,男183例,女122例。平均年龄8.4±0.3岁(5～18岁)。白天有尿频、尿急、湿裤症状的复杂性遗尿病例225例,占73.8%;单症状性夜间遗尿病例80例,占26.2%。88.2%的患儿有效膀胱容量减小,其中单症状性夜间遗尿患儿中,82.1%存在有效膀胱容量减小,而复杂性遗尿患儿中90.0%有此现象,二者相比,差异有统计学意义(P<0.05)。7～14岁女孩最大尿流率平均为19.7±1.2ml/s,明显小于正常(P<0.05),男孩为18.6±1.1ml/s。尿流率曲线中钟形曲线占54.8%;Staccato排尿曲线占12.5%;间断排尿曲线占7.2%;功能性膀胱出口梗阻形曲线占14.4%。128例(占42.0%)患儿排尿时出现收缩的肌电图信号。结论通过尿流率分析发现部分原发性遗尿症患儿存在膀胱尿道功能异常,表现为有效膀胱容量减小、最大尿流率降低和逼尿肌-括约肌收缩不协调等。与尿动力学检查相比,尿流率检测无创易行,值得在原发性遗尿症儿童中进行。     

伴排尿障碍的隐性脊柱裂患儿的尿动力学特点

目的 研究伴有排尿功能障碍的隐性脊柱裂患儿的尿动力学特征.方法 对113例有排尿障碍的患儿进行尿动力学检查,其中48例经X线确诊为隐性脊柱裂者为观察组,无脊柱裂65例为对照组.检测项目包括:尿流率测定、充盈期膀胱压力容积测定、压力流率测定、同步括约肌肌电测定、静态尿道压力测定.比较两组间主要尿动力参数异常的发生率.观察组按主要临床症状分为尿失禁、尿频、单纯夜间遗尿和排尿困难4组,应用统计学研究临床症状与尿动力学主要参数的相关性.结果 在检测中发现观察组48例中有46例有不同程度的异常.其中逼尿肌过度活动22例,排尿期逼尿肌活动低下和无收缩21例,最大尿流率降低18例,膀胱容积缩小15例,残余尿量增多12例,低顺应性膀胱7例,逼尿肌外括约肌协同失调4例,最大尿道压降低4例.观察组中逼尿肌过度活动、逼尿肌活动低下、残余尿量增多及低顺应性膀胱发生率更高.按临床症状来看,隐性脊柱裂伴有尿失禁的患儿更多的表现为逼尿肌活动低下及最大尿流率降低,尿频的患儿在尿动力检查中多表现为逼尿肌过度活动及残余尿增多,排尿困难的患儿逼尿肌活动低下的发生率更高,而遗尿的患儿更易检出逼尿肌过度活动.结论 小儿隐性脊柱裂伴有排尿功能障碍的患儿具有多种尿动力学改变,且相同的症状可表现为不同类型的尿动力学异常,临床症状与尿动力学参数有一定的相关性,尿动力检查为其临床诊断和治疗方案制定提供重要客观依据.     

尿动力学检测在小儿膀胱横纹肌肉瘤术后膀胱功能康复中的评价及临床意义

目的 通过尿动力学检测评价小儿膀胱横纹肌肉瘤(rhabdomyosarcoma,RMS)术后膀胱功能恢复情况,以指导临床用药及膀胱功能训练,促进膀胱功能恢复,减少并发症.方法 收集2003年8月至2013年8月间收治的12例膀胱RMS患儿的临床资料及排尿日记并实施尿动力学检测,依据其检测结果指导膀胱功能训练,包括盆底肌肉训练、尿意习惯训练及指导临床用药,并对影响术后膀胱功能恢复相关因素进行分析.结果 本组术后行尿动力学检查并指导膀胱功能训练,除1例复发死亡外,11例中膀胱控尿功能良好9例,白天排尿间隔时间1～3 h,夜间排尿0～2次;压力性尿失禁1例,白天排尿间隔时间30～40 min,夜间排尿2～3次;另1例尚在膀胱训练治疗中.最后一次尿动力学检测见膀胱内压、最大膀胱测压容量、残余尿量、尿流率、膀胱顺应性均正常9例;1例术后伴压力性尿失禁,通过膀胱功能训练,现最大膀胱测压容量约135 ml,为最小膀胱容量估计值的90％,而残余尿量、膀胱内压、尿流率未见明显异常,膀胱控尿功能有所改善;另1例术后6个月,最大膀胱测压容量偏小,膀胱顺应性偏低,正进行膀胱功能训练.结论 膀胱RMS患儿术后,虽使用化疗药物,但膀胱功能未受到明显不利影响;尿动力学检测能准确评价膀胱RMS术后膀胱功能恢复情况,用于指导术后膀胱功能训练及用药,对促进术后膀胱功能的康复具有重要的临床意义.     

B超影像尿动力学检查在诊断小儿下尿路功能障碍中的应用

目的探讨B超影像尿动力学检查在下尿路功能障碍患儿诊断中的应用价值。方法69例小儿分2组，患儿组54例，为下尿路功能障碍的患儿，男30例，女24例，年龄4～18岁，平均（10．7±3．6）岁；对照组15例，为下尿路正常的患儿（因上尿路异常作下尿路检查者），男11例，女4例，年龄3～17岁，平均（9．9±3．7）岁。分别进行尿动力学检查，同步耻骨上、会阴部和直肠B超观察膀胱壁厚度、膀胱颈口形态、膀胱充盈和排尿后尿道形态等。结果患儿组尿动力学异常表现有残余尿量增多、膀胱顺应性降低、逼尿肌过度活动、逼尿肌括约肌协同失调和逼尿肌瘫痪等，B超影像检查异常表现有膀胱壁增厚、毛糙，颈口抬高，后尿道扩张，排尿期尿道开放不完全等，其中2例后尿道瓣膜患儿发现膀胱憩室。对照组B超影像检查显示充盈期膀胱壁光滑，厚度（2±1）mm，均小于3mm；膀胱颈口关闭，无抬高；排尿期膀胱颈口、后尿道充分开放，残余尿量小于10ml。结论B超影像尿动力学检查可将膀胱的功能性改变和形态学信息相结合，能更全面准确地诊断和了解下尿路功能障碍。     

重视小儿排尿功能障碍的诊治

小儿排尿功能障碍多见。常见临床表现有尿频、尿急、尿痛、尿失禁、排尿困难和遗尿等。正确诊断是成功有效治疗的基础。尿动力学检查的普及显著提高了诊断和治疗水平,已经成为诊断排尿障碍的常用工具。小儿首选无创尿动力学检查包括排尿日记、尿流率和残余尿测定及排尿方式观察等。有创尿动力学检查包括膀胱尿道置管测压和影像尿动力学检查。引起排尿异常的常见病有排尿功能发育延迟、泌尿系感染、神经源性膀胱、膀胱过度活动症(OAB)、遗尿症等。尿动力学检查有助于理解发病机制和分类从而科学制定治疗方案。排尿功能障碍除了影响生活质量外,常引起逼尿肌和上尿路继发损害,甚至危及生命。因此,应重视小儿排尿功能障碍的诊治。     

尿动力学评估小儿尿道外伤Ⅱ期尿道成形术疗效的意义

目的　探讨尿动力学测定在评估小儿尿道外伤后Ⅱ期尿道成形术疗效的意义。方法　4 1例小儿尿道外伤后行Ⅱ期尿道成形术 (男 32例 ,女 9例 ,年龄范围 3～ 17岁 ,平均 10± 4岁 ) ,外伤后 3～ 9个月 ,平均 6 .5个月。分为第 1组 16例 ,行内窥镜尿道成形术 ;第 2组 2 5例 ,行经会阴尿道成形术 ;术后 1个月行自由尿流率测定和膀胱压力流率测定 ,记录尿流率 (Qmax)、自由排尿量 (VV)、残余尿量 (PVR)、最大尿流率时逼尿肌压力 (PdetatQmax)和A/G值。对照组 10例 (男 7例 ,女 3例 ,年龄范围 3～ 12岁 ,平均 8± 4岁 ) ,因上尿路疾病需要手术治疗而下尿路功能正常。结果　Qmax、VV、PVR、PdetatQmax和A/G在第Ⅰ组、第Ⅱ组和对照组之间的差异无统计学意义 (P >0 .0 5 )。P Q图示第Ⅰ组 13例位于非梗阻区、1例位于可疑梗阻区、2例位于梗阻区 ;第Ⅱ组 2 0例位于非梗阻区、1例位于可疑梗阻区、4例位于梗阻区。二组位于非梗阻区的差异无统计学意义 (P >0 .0 5 )。结论　掌握好适应证 ,内窥镜尿道成形和经会阴开放尿道成形术均可达到治疗目的。小儿尿动力学测定可以评估小儿外伤后Ⅱ期尿道成形术后的尿道功能 ,帮助早期发现尿道狭窄。     

儿童精神性尿频的尿动力学变化

目的 探讨儿童精神性尿频的病因、病理生理变化及其治疗。方法 本组38例，应用尿流动力仪分别记录排尿量、尿流曲线、膀胱压力容积及压力－流率－肌电图。结果 38例中，4例尿动力学安全正常；34例出现膀胱功能异常，占89.5%(34/38)，其中逼尿肌不稳定性收缩者12例，低顺应性膀胱者6例，低顺应性膀胱合并逼尿肌不稳定性收缩者16例；最大膀胱测量容量百分数下降14例。排尿期异常仅5.3%(2/38)，为尿道括约肌过度活跃。尿动力学检测后，84.2%的患儿症状完全消失或好转。结论 逼尿肌不稳定性收缩是最主要的病理生理学改变；排尿训练是主要治疗措施。     

Bladder perforation in augmentation cystoplasty during urodynamic investigation: A case report and review of the literature

BackgroundSpontaneous bladder rupture is a known complication of augmentation cystoplasty. We report the second case of bladder rupture during filling cystometry many years after bladder augmentation and the first case occurring in a patient with an autoaugmentation cystoplasty. In addition, the management and outcome for a bladder perforation in an autoaugmentation cystoplasty will be discussed.CaseA 20-year-old male with a history of an L4 myelomeningocele underwent an autoaugmentation cystoplasty for neurogenic bladder dysfunction and decreased bladder wall compliance five years previously. He self catheterized four times daily. During filling cystometry, detrusor pressure increased to 60 cm H₂O with 300 mL filling. Detrusor pressure then rapidly decreased to 20 cm H₂O without evidence of external leakage. The infusion was immediately stopped and X-ray showed intraperitoneal leakage of contrast material. Serial abdominal examination demonstrated worsening abdominal distension. Exploratory laparotomy revealed a 2 cm perforation within the autoaugment portion of the bladder.ConclusionAn autoaugmentation cystoplasty improves bladder compliance and capacity with the use of native urothelial tissue. Although perforation after autoaugmentation has not been previously reported, caution must be used during urodynamic evaluation in patients with decreased bladder wall compliance and augmentation cystoplasty.     

Bladder augmentation and artificial sphincter implantation: urodynamic behavior and effects on continence

ObjectiveTo quantify changes in bladder capacity, pressure and compliance after isolated bladder augmentation or augmentation associated with implantation of an artificial sphincter, and to compare the various types of augmentation.Patients and methodsPreoperative and postoperative urodynamic studies were performed in a group of 38 patients (18 males and 20 females; age range 2–19 years), who underwent a type of bladder augmentation.ResultsThe bladder improved in capacity in all patients (mean values: initial 137 ml, final 336 ml, individual increase 229 ml; 434%) except two, in which the augmentation was done with ureter. The mean pressure improved (initial 32 cm of H₂O, final 14, decrease per patient 18 cm of H₂O; 49%). The curve of compliance, progressively increasing typical of hyperreflexia and poor compliance, present in 70% of the cases preoperatively, improved in 78% cases postoperatively, although there were several different patterns. Urodynamic behavior was analyzed with regard to the tissue used for augmentation (ileum, ureter or sigmoid colon). In the sigmoid colon group, there were no significant differences in the urodynamic behavior of the bladder neo-reservoir in relation to the configuration used.ConclusionWith bladder augmentation comes an increase in bladder capacity, a reduction in pressure, and an improvement in compliance and continence. The level of change in capacity, pressure and compliance varies with the tissue used and the length and caliber of the insert. When the procedure is carried out using sigmoid colon tissue, there are no noteworthy differences among the various possible configurations.     

小儿原发性夜间遗尿症尿动力学评价的初步探讨

目的 探讨小儿原发性夜间遗尿症的病因和膀胱功能改变。方法 本组63例，男39例，女24例。在清醒和自然睡眠相进行充盈期膀胱压力容积测定，记录睡眠相盆底肌电活动变化。结果 58例存在膀胱功能紊乱，多种异常合并为五种模式。其中，睡眠相逼尿肌不稳定收缩占71.4%(45/63)，睡眠相膀胱最大测量容量下降占36.5%(23/63)。睡眠相逼尿肌不稳定收缩出现时，逼尿肌与盆底肌肉协同失调者11例。结论 逼尿肌不稳定收缩是遗尿发生的主要原因，盆底肌肉与逼尿肌的协同失调可能是原因之一，膀胱容量下降是逼尿肌不稳定收缩所致的遗尿结果而不是原因。     

超声测量膀胱壁厚度预测脊柱裂患儿上尿路损害

目的 通过超声测定膀胱壁厚度和尿动力学检查测定膀胱功能,评价隐形脊柱裂患儿膀胱厚度和功能及上尿路损害的相关性,探讨用膀胱壁厚度评估隐性脊柱裂患儿上尿路损害的可能性.方法 选取超声检查确诊上尿路扩张的隐性脊柱裂患儿22例,年龄(8.8±4.9)岁,并选择同期超声检查无上尿路扩张的隐性脊柱裂患儿29例作为对照组,年龄(9.3±5.3)岁.所有患儿均行尿动力学检查,记录最大膀胱容量,充盈期最大逼尿肌压力,逼尿肌漏尿点压和逼尿肌过度活动最高压力.在膀胱充盈至预测正常膀胱容量的60%时行超声检查测量逼尿肌厚度.同时根据超声检查是否扩张将患儿分为有和无上尿路损害组,比较两组膀胱壁厚度的差异,并分析膀胱厚度与尿动力学参数相关性,计算膀胱壁厚度预测上尿路损害统计学指标.结果 上尿路损害组平均膀胱壁厚度(3.4±0.25)mm,显著高于无上尿路损害组的(2.5±0.45)mm,差异有统计学意义(P＜0.05).膀胱壁厚度与逼尿肌过度活动最高压力、逼尿肌漏尿点压和充盈期最大逼尿肌压力均呈正相关(r=0.87、0.91和0.85,P＜0.0001,P＜0.0001和P=0.017).膀胱壁厚度≥3.0 mm预测上尿路损害的灵敏度为90.9%,特异性为79.4%,阳性预测值76.9%,阴性预测值为92.0%.受试者工作特征曲线(ROC)显示超声测量膀胱壁厚度能高度预测隐形脊柱裂患儿上尿路损害的发生,曲线下面积(AUC)为0.929.结论 超声测定隐形脊柱裂患儿膀胱壁厚度可以帮助预测上尿路损害,膀胱壁厚度大于3.0 mm提示隐性脊柱裂患儿上尿路损害可能性大.     

Innovation in Urodynamics – Cystometry with Gas Perfused Catheters with Helium

PurposeProof of the fitness of the Gaserfusion method with helium for urodynamic studies on the basis of simultaneous comparative cystometries between Waterperfusion and Gasperfusion. Introduce gasperfusion to cystometry with children. Development of a combined measuring instrument for urodynamic and manometry of anorectum and esophagus.Material and MethodsPressure changes were measured with Gasperfusion in an artificial bladder in different positions and under movements. During 62 urodynamic investigations of 33 young patients between 5 months and 25 years 562 active (coughing) or passive (manual pressure at the bladder) provocation tests were performed. With the simultaneous measurement of the amplitudes of pressure changes in time in the bladder with two urethraly placed double channel catheters (6French), we get the velocity of pressure increase and could compare the common Waterperfusion with the new Gasperfusion using helium perfused catheters.ResultsIn the artificial bladder the pressure wasn`t changing either due to movement or different positions of the bladder. The Investigation of children shows the statistic significant higher velocities of pressure changes of the Gasperfusion than those measured with Waterperfusion.ConclusionsThe Gasperfusion has a lot of advantages for urodynamic investigations especially in children. The child can be measured in all possible body positions and during changing the body position. Helium is not dangerous for the human . The study with children showed better measuring results of the Gasperfusion especially in fast pressure changes like provocation and stress. We conclude that the Gasperfusion with helium is an excellent alternative to the common techniques using Waterperfusion and recommend the use of Gasperfusion in urodynamic studies espacially for children. Following these results it could be possible to have a new combination of equipment for measuring urodynamics and manometry of the gastrointestinal tract.     

尿动力学检测在儿童尿频症中的应用

目的 探讨儿童白天尿频症的尿流动力学病理改变和治疗方法.方法 随机选择40例白天尿频症患儿,进行尿动力学检测,观察尿流曲线、功能性膀胱容量(FBC)、逼尿肌稳定性及不稳定性指数、膀胱顺应性(BC)、最大膀胱测量容量(CBCmax)及CBCmax百分数、逼尿肌与尿道外括约肌协同性.在充盈性膀胱内压测定过程中当膀胱容量达正常CBCmax之前出现逼尿肌不稳定性收缩(DI)时嘱患儿收紧盆底肌、延长储尿时间,进行膀胱储尿功能训练,其中20例合并有DI的患儿在相同条件下间隔30 min再行充盈性膀胱内压测定,比较两次测定的CBCmax百分数和不稳定指数.同期选15名排尿正常儿童做对照研究.结果 膀胱充盈期出现DI 17例,DI合并低顺应性膀胱15例,单纯低顺应性膀胱4例,充盈性膀胱内压测定正常4例.3例排尿期盆底肌电活动间断增强.CBCmax下降28例.第1次CBCmax与FBC比较有明显增加(P＜0.05).20例进行2次充盈性膀胱内压测定,第2次逼尿肌不稳定指数明显下降(P＜0.05)、CBCmax百分数明显增加(P＜0.05).而正常对照组2次CBCmax无明显差异.结论 儿童白天尿频症的主要尿动力学病理变化是DI,低顺应性膀胱和CBCmax降低是DI引起逼尿肌收缩的继发改变,均为功能性紊乱,而非膀胱壁组织结构器质性病变.行为疗法是治疗儿童尿频症的有效方法,其中以排尿训练为主,抗胆碱能药可辅助治疗儿童尿频症.     

Effects of male sex hormones on urodynamics in childhood: intersex patients are a natural model

 The effects of sex hormones on bladder function have been evaluated in adult females, especially in regard to postmenopausal incontinence and bladder irritability syndromes. These have not been investigated in children in regard to urodynamic findings. An intersex patient whose bladder is under the influence of androgens is a natural model to investigate the effects of male sex hormones on bladder function in females. To evaluate the urodynamic findings and clinical symptoms in a group of intersex patients and to determine how androgens influence bladder function in female children, clinical and urodynamic records of 12 intersex patients with adrenogenital syndrome were investigated retrospectively. The mean age was 9 ± 5.7 years (1.5–18) and the mean follow-up period was 5.1 ± 4.4 years (1–12). Congenital adrenal hyperplasia (CAH) was present in all cases. Only 3 patients had urinary symptoms and incontinence, but these findings did not correlate with their urodynamic findings. None of the patients required medications for their urinary symptoms. Nine are still being treated medically by the pediatric endocrine team with hydrocortisone for CAH. The upper urinary tract was found to be normal with no hydronephrosis. The mean bladder capacity (269 ± 122 ml) was lower (86.7%) than the estimated capacity for age. The mean compliance was 20 ± 13.7 ml/cmH₂O. No unstable detrusor contractions were encountered. The most remarkable finding was this reduced bladder capacity of androgenized female patients for age, which shows the antagonistic effect of androgens on bladder urodynamics in females. Accepted: 11 January 2000     

神经源性膀胱伴输尿管反流的尿动力学研究

目的 探讨有输尿管反流的神经源性膀胱(NB)患儿有或没有逼尿肌过度活动(DO)时的尿动力学差异,为临床治疗此类患儿提供理论参考依据.方法 选取2013～2015年就诊并经影像尿动力学检查发现膀胱输尿管反流的NB患儿68例,男30例,女38例,年龄4～12岁,平均7.5岁.按照充盈期有DO,将其分为DO组(n=20)与无DO组(n=48).观察记录两组发生膀胱输尿管反流时的膀胱灌注量、逼尿肌压并计算发生反流时的膀胱顺应性;记录两组充盈结束时最大膀胱测压容量、最大逼尿肌压、并计算充盈期膀胱顺应性.结果 DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(98.7±16.1)ml和(5.2±1.9) ml/cmH2O,无DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(127.3±36.3)ml,(7.1±2.1)ml/cmH2O,差异均有统计学意义(P＜0.05);两组的逼尿肌压分别为(21.6±9.2)cmH2O、(19.2±7.4)cmH2O,差异没有统计学意义;DO组充盈结束时的膀胱容量与顺应性分别为(182.7±31.2)ml、(5.4±1.7) ml/cmH2O,与无DO组充盈结束时的膀胱容量(230.6±34.6)ml与顺应性(6.5±1.1)ml/cmH2O相比,差异有统计学意义;两组尿动力学检查结束时逼尿肌压分别为(33.8±7.8)cmH2O、(36.4±8.1)cmH2O,差异没有统计学意义.结论 膀胱容量小,膀胱顺应性差是有输尿管反流的NB患儿伴发DO时的尿动力学特征.     

Posterior urethral valves after infancy–urodynamic consequences

This study describes a subset of patients with posterior urethral valves (PUV) who presented late in childhood. The objective was to identify factors that lead to back-pressure effects on the upper tracts, which persist in spite of adequate valve ablation in some patients, and seek factors that may preserve the upper tracts despite untreated obstruction in other patients. Six children with PUV diagnosed after infancy were evaluated. The pre-operative work-up included renal biochemistry, ultrasonography, voiding cystourethrography, and uroflowmetry. Detailed urodynamic studies, including uroflowmetry and slow-fill cystometry, were performed in all cases 6 months after surgery. Adequacy of valve fulguration was confirmed by urethroscopy. Three of the six patients had normal upper tracts; in these, there was marked improvement in peak urine flow rates after fulguration and bladder pressures were normal. The other three patients had bilateral hydroureteronephrosis, and two had chronic renal failure. This group had markedly decreased functional bladder capacity with loss of compliance at low bladder volumes and significant residual urine volumes in spite of adequate valve fulguration, suggesting myogenic detrusor failure. We conclude that in patients with PUV presenting beyond the age of 5 years, upper-tract deterioration may accompany high storage pressures in the bladder. In some boys with long-standing obstruction the upper tracts may escape damage; in our series this was associated with normal bladder dynamics and appeared unrelated to the severity or duration of outflow obstruction. Accepted: 13 August 1997